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Mirea D, Manea MC, Bejinariu NI, Mocanu B, Ciocâlteu AM, Ţigliş M, Peride I, Neagu TP, Mirea LE, Lascăr I. Cervical intranodal schwannoma - a rare diagnosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:209-212. [PMID: 36074686 PMCID: PMC9593123 DOI: 10.47162/rjme.63.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Intranodal schwannoma is a rare benign tumor, which originates from the peripheral nerve sheath (Schwann cells), fewer cases being reported with lymphatic involvement. We present the case of a middle-aged female patient, with one-year growing mass in the lateral-cervical area, in intimate relation with the vascular package of the neck. Preoperative cervical computed tomography examination showed the tumor features. There was no intraoperative complication, with the piece being completely removed. The morphological examination revealed the structure of a lymph node, and after Hematoxylin-Eosin staining, there were eosinophilic cytoplasm, euchromatic nuclei, with round, elongated or slightly wavy form and reduced pleomorphism, rare degenerative nuclear atypia, and no mitotic activity nor necrosis. The expression of S100 protein on immunohistochemistry, along with negative results for smooth muscle actin and desmin sustained the diagnosis of intranodal schwannoma of the neck. With a low index of cellular proliferation (Ki67), this case is in line with the reported features of schwannoma having extremely rare malignant transformation.
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Affiliation(s)
- Daniel Mirea
- Department of Otolaryngology, Ponderas Academic Hospital, Bucharest, Romania
| | | | | | - Bogdan Mocanu
- Department of Neurosurgery, Brain Institute, Monza Hospital, Bucharest, Romania
| | - Alina Mihaela Ciocâlteu
- Clinical Department No. 12 – Ophthalmology, Otolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Emergency Clinical Hospital, Bucharest, Romania
| | - Mirela Ţigliş
- Clinical Department No. 14 – Orthopedics, Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Anesthesia and Intensive Care, Emergency Clinical Hospital of Bucharest, Romania
| | - Ileana Peride
- Clinical Department No. 3 – Nephrology, Urology, Immunology, Transplant Immunology, Dermatology, Allergology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology and Dialysis, St. John Emergency Clinical Hospital, Bucharest, Romania
| | - Tiberiu Paul Neagu
- Clinical Department No. 11 – Plastic and Reconstructive Surgery, Pediatric Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania
| | - Liliana Elena Mirea
- Clinical Department No. 14 – Orthopedics, Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Anesthesia and Intensive Care, Emergency Clinical Hospital of Bucharest, Romania
| | - Ioan Lascăr
- Clinical Department No. 11 – Plastic and Reconstructive Surgery, Pediatric Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania
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Ostrow KL, Donaldson KJ, Caterina MJ, Belzberg A, Hoke A. The Secretomes of Painful Versus Nonpainful Human Schwannomatosis Tumor Cells Differentially Influence Sensory Neuron Gene Expression and Sensitivity. Sci Rep 2019; 9:13098. [PMID: 31511601 PMCID: PMC6739480 DOI: 10.1038/s41598-019-49705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/27/2019] [Indexed: 01/08/2023] Open
Abstract
Schwannomatosis is a multiple tumor syndrome in which patients develop benign tumors along peripheral nerves throughout the body. The first symptom with which schwannomatosis patients often present, prior to discovery of tumors, is pain. This pain can be debilitating and is often inadequately alleviated by pharmacological approaches. Schwannomatosis-associated pain can be localized to the area of a tumor, or widespread. Moreover, not all tumors are painful, and the occurrence of pain is often unrelated to tumor size or location. We speculate that some individual tumors, but not others, secrete factors that act on nearby nerves to augment nociception by producing neuronal sensitization or spontaneous neuronal firing. We created cell lines from human SWN tumors with varying degrees of pain. We have found that conditioned medium (CM) collected from painful SWN tumors, but not that from nonpainful SWN tumors, sensitized DRG neurons, causing increased sensitivity to depolarization by KCl, increased response to noxious TRPV1 and TRPA1 agonists and also upregulated the expression of pain-associated genes in DRG cultures. Multiple cytokines were also detected at higher levels in CM from painful tumors. Taken together our data demonstrate a differential ability of painful versus non-painful human schwannomatosis tumor cells to secrete factors that augment sensory neuron responsiveness, and thus identify a potential determinant of pain heterogeneity in schwannomatosis.
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Affiliation(s)
- Kimberly Laskie Ostrow
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA. .,Neurosurgery Pain Research Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| | - Katelyn J Donaldson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Michael J Caterina
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Neurosurgery Pain Research Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Allan Belzberg
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Neurosurgery Pain Research Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ahmet Hoke
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Silvestre CF, Tavares JA, López-Presa D, dos Santos VR, Rocha J, João Bugalho M. Cervical Lymph Node Schwannoma-An Unexpected Diagnosis. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2019; 12:2632010X19829239. [PMID: 30915425 PMCID: PMC6429639 DOI: 10.1177/2632010x19829239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Schwannomas-Schwann cells-originating tumors-may develop in many locations. However, primary schwannomas arising within lymph nodes are extremely rare, with only a few cases described to this date in the English literature. For the intranodal location, most of the cases are described in the abdominal cavity. In these cases, clinicians may consider and check for familial disorders, such as neurofibromatosis type 2 (NF2) and schwannomatosis also called neurofibromatosis type 3. Schwannomas are benign neoplasms. Histologically, differential diagnosis for spindle-cell lesions in lymph nodes is important and must be done carefully, mainly because they may be attributable to metastatic disease. We report a case of a primary schwannoma arising in a cervical lymph node. BACKGROUND Primary schwannomas arising within lymph nodes are extremely rare, with only a few cases reported. Since they are benign neoplasms, the differential diagnosis with other intranodal spindle cell lesions, mostly malignant, is important. METHODS An asymptomatic 69-year-old woman, previously submitted to left hemithyroidectomy for a benign folicular nodule, underwent thyroidectomy totalization following the identification of a large thyroid nodule in routine evaluation. RESULTS Gross and microscopic examination and ancillary studies were consistent with the diagnosis of intranodal schwannoma. The patient had acquired bilateral hypoacusia. Therefore, type 2 neurofibromatosis was considered and vestibular schwannomas ruled out. CONCLUSION Herein, we present the second case of a primary schwannoma in a cervical lymph node reported so far. The relevance of the differential diagnosis is highlighted.
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Affiliation(s)
| | - Joana Almeida Tavares
- Department of Pathology, Santa Maria Hospital, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - José Rocha
- Department of Surgery, Santa Maria Hospital, Lisbon, Portugal
| | - Maria João Bugalho
- Department of Endocrinology, Diabetes and Metabolism, Santa Maria Hospital, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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